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Infections of the Spinal Subdural Space in Children: A Series of 11 Contemporary Cases and Review of all Published Reports. A Multinational Collaborative Effort

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Abstract

Introduction

Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized infection in the central nervous system. Infectious processes of the subdural spinal space include subdural spinal empyema, subdural spinal abscess, infected spinal subdural cyst, and infectious spinal subdural cyst. To date, there has been no systematic review of these entities in children, with the cumulative knowledge of the pathophysiologic, microbiologic, and demographic characteristics of these infections relegated solely to few small series and case reports.

Methods

A series of 11 recent cases culled from the collaboration of international authors are presented. In addition, an exhaustive MEDLINE search and manual review of the international literature was performed, identifying a total of 73 cases of spinal subdural infections in patients under the age of 21. Data of interest include the age, sex, signs, and symptoms at presentation, spinal location of infection, presence of spinal dysraphism, and other comorbidities, offending organism, treatment, outcome, and follow-up.

Results

Patients ages ranged from 4 weeks to 20 years (mean, 6.5 years). Males outnumbered females by a ratio of 2:1. Over half (53 %) of spinal subdural infections in children were associated with spinal dysraphism or other congenital abnormalities of the spine. The commonest organism to infect the spinal subdural space in children is mycobacterium tuberculosis and the thoracic spinal region was most commonly infected.

Conclusions

The disease is usually treated surgically, although a more expectant approach consisting of antibiotics and observation has also been proposed.

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Acknowledgments

The primary author (ALS) would like to thank Dr. Eugene S. Flamm, MD for his support of this project. Ely Rosenstock, MBA, Rachel Fink, and Geraldine Kelly for their assistance are thanked as well.

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Authors and Affiliations

  1. Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, 10467, USA

    Adam L. Sandler, James T. Goodrich, Eliezer Kolatch, Reza Yassari, Lawrence B. Daniels III, Arundhati Biswas & Rick Abbott

  2. Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, UK

    Dominic Thompson

  3. Department of Neurological Surgery, Hackensack University Medical Center, Hackensack, NJ, USA

    Mostafa El Khashab

  4. Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran

    Farideh Nejat

  5. Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands

    Jasper van Aalst & Erwin Cornips

  6. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Sandeep Mohindra

  7. Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India

    Rahul Gupta

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  1. Adam L. Sandler
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Correspondence to Adam L. Sandler.

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Sandler, A.L., Thompson, D., Goodrich, J.T. et al. Infections of the Spinal Subdural Space in Children: A Series of 11 Contemporary Cases and Review of all Published Reports. A Multinational Collaborative Effort. Childs Nerv Syst 29, 105–117 (2013). https://doi.org/10.1007/s00381-012-1916-4

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